An epidemiological study of dental caries and associated risk factors among primary school children in the Aileu Municipality, Timor-Leste

Background: Recent evidence indicates that the oral health for children in Timor-Leste is deteriorating with 40% of school children experiencing toothache during 2014. Timorese have easy access to sugar, poor food security and lack of water fluoridation, all of which exacerbates the risk of dental caries.

Purpose: There is a lack of quality epidemiological data available to confirm anecdotal information of high caries rates in rural and remote Timor-Leste. Such data is required to inform oral health issues and health policy at both the local and National level. This study investigated the caries status and potential risk factors among primary school children in the rural Aileu Municipality of Timor-Leste.

Objectives: To determine, (1) caries prevalence and experience, (2) the status (active/arrested) of existing caries lesions and (3) associations between dental caries and potential risk factors, among primary school children in the Aileu Municipality, Timor-Leste.

Methods: This study analysed secondary data. De-identified data for this analysis were obtained from North Richmond Community Health, Richmond (NRCH), Melbourne, Australia. North Richmond Community Health (NRCH) has been working with the Friends of Aileu (a government to government partnership between an Australian Local Government Area and the Municipality of Aileu) to improve the oral health of school children in the Municipality of Aileu. NRCH conducts an outreach school-based oral health promotion program, called Kose Nehan, at six primary schools in the Aileu Municipality of Timor-Leste. Caries was diagnosed using the International Caries Detection and Assessment System (ICDAS) and reported using the DMFT index. Examiners were trained and calibrated. A brief interviewer administered questionnaire was used to capture information on child oral hygiene and diet behaviours. For the analysis dental caries was defined as ‘any caries lesions’ (ICDAS caries codes 1-6). Descriptive and inferential analyses were conducted using STATA 14. Multivariable logistic regression analysis predicting the odds of dental caries (yes/no) was used to determine independent associations between the exposures and the outcome.

Results: Data were analysed for 685 children. In the primary dentition, the overall prevalence of caries was 64% and the mean dmft score was 2.74 (SD 3.08). In the permanent dentition, the overall prevalence of was 53% and the mean DMFT score was 1.74 (SD 2.46). Overall, approximately 84% of caries lesions were identified as being active. The multivariable regression analysis did not identify independent predictors of caries.

Conclusions: Dental caries was highly prevalent among this population and urgent action is required to reduce the population burden of this disease. Malnutrition, which was not measured for this study, is highly prevalent among children in Timor-Leste and could be the explanatory factor for the high caries rates in this population. The effect of malnutrition on dental caries and vice versa needs further investigation.